The comparative study of the plan quality between volumetric modulated arc therapy (VMAT) and 3D conformal therapy (3DCRT) for the treatment of selected representative childhood neoplasms was performed.

During the year 2013, 44 children with neoplasms were irradiated using VMAT. The 3DCRT plans were created retrospectively and compared with the VMAT plans for four tumour locations. The conformity parameters, dose volume histograms for target volume and organs at risk, number of monitor units and time used to deliver the single fraction were evaluated and compared for each plan. Additionally, for patients with brain tumour the comparison of different arcs configuration was made.

VMAT modality presented the superiority over older conformal methods with regard to the improvement in the dose conformity and normal tissue sparing. The noncoplanar arcs arrangement was beneficial in the decrease of high-dose volume and the protection of the organs at risk located oppositely to the target volume.

VMAT could be preferred technique for treating childhood neoplasms, especially when the complex-shaped target volume is localised close to the critical structures. The noncoplanar arcs arrangement could be the method of choice in the reirradiated patients and in these with laterally located brain tumours.

The amount of energy deposited on any organ by ionising radiation termed absorbed dose, plays an important role in evaluating the risks associated with the administration of radiopharmaceuticals. In this research work, the absorbed dose received by human organs for 153Sm-TTHMP and 153Sm-PDTMP was evaluated based on biodistribution studies on the Syrian rats.

153Sm-TTHMP and 153Sm-PDTMP were successfully prepared with radiochemical purity of higher than 99%. The biodistribution of the complexes was investigated within the Syrian rats up to 48 hours post injection. The human absorbed dose of the complexes was estimated by the radiation dose assessment resource method.

The highest absorbed dose for 153Sm-TTHMP and 153Sm-PDTMP was observed in the trabecular bone with 1·085 and 1·826 mGy/MBq, respectively. The bone to other critical organ dose ratio for 153Sm-PDTMP is significantly greater than 153Sm-TTHMP. Also, the bone/red marrow dose ratio for these complexes is comparable with this ratio for 153Sm-EDTMP, as the most clinically used Sm-153 bone pain palliative radiopharmaceutical.

According to the considerable bone absorbed dose against the insignificant absorbed dose of non-target organs, these complexes can be used as potential bone pain palliative agents in clinical applications.

This study was designed to evaluate whether radiographer-led on-treatment review clinics are meeting the wider needs of prostate patients receiving radiotherapy.

Semi-structured interviews were used to elicit patient and staff perspectives. Interviews are used extensively in qualitative research to produce a breadth and depth of insight into participants’ experiences and opinions. Seven patients and two radiographers participated in individual audio-taped interviews. Thematic analysis of the data identified some key themes and their perceived importance within the review service for both patients and staff.

Semi-structured interviews were used to elicit patient and staff views. Several themes emerged from patient and radiographer perspectives. Radiographers and patients both expressed overall satisfaction with the service. Strengths included staff communication, relaxed environment, individualised support, regular information spread throughout the review pathway and consistency in managing acute side effects. Weaknesses included information and communication gaps at the beginning and end of treatment, information inconsistency between staff groups, gaps in specialist knowledge and a possible gap in skills where staff could train as supplementary prescribers.

Interviews produced an in-depth view of patient and staff experiences. Staff and patients identified both strengths and areas for improvement within the local service. Study findings support review radiographers in sourcing additional specialist training and a closer collaboration with other staff groups, which will further develop the service. As a next step, triangulation of research methods with questionnaires could be used to evaluate whether this small sample of patients is characteristic of prostate patients in general.

To evaluate the inter-fraction variation in interstitial high-dose-rate (HDR) brachytherapy. To assess the positional displacement of catheters during the fractions and the resultant impact on dosimetry.

Although brachytherapy continues to be a key cornerstone of cancer care, it is clear that treatment innovations are needed to build on this success and ensure that brachytherapy continues to provide quality care for patients. The dosimetric advantages offered by HDR brachytherapy to the tumour volume rely on catheter positions being accurately reproduced for all fractions of treatment.

A total of 66 patients treated over a period of 22 months were considered for this study. All the patients underwent computer tomography (CT) scan and three-dimensional treatment planning was carried out. Brachytherapy treatment was delivered by the HDR afterloading system. On completing the last fraction, CT scan was repeated and treatment re-planning was done. The variation in position of the implanted applicators and their impact on dosimetric parameters were analysed using both the plans.

For all breast-implant patients, the catheter displacement and D90 dose to clinical target volume were <3 mm and 3%, respectively. The displacement for carcinoma of the tongue, carcinoma of the buccal mucosa, carcinoma of the floor of mouth, carcinoma of the cervix, soft-tissue sarcoma and carcinoma of the lip were comparatively high.

Inter-fraction errors occur frequently in interstitial HDR brachytherapy. If no action is taken, it will result in a significant risk of geometrical miss and overdose to the organs at risk. It is not recommended to use a single plan to deliver all the fractions. Imaging is recommended before each fraction and decision on re-planning must be taken.

A retrospective planning study comparing volumetric arc therapy (VMAT) and stereotactic body radiotherapy (SBRT) treatment plans for non-small cell lung cancer (NSCLC).

Five randomly selected early stage lung cancer patients were included in the study. For each patient, four plans were created: the SBRT plan and three VMAT plans using different optimisation methodologies. A total of 20 different plans were evaluated. The dose parameters of dose conformity results and the target dose constraints results were compared for these plans.

The mean planning target volume (PTV) for all the plans (SBRT and VMAT) was 18·3 cm3, with a range from 15·6 to 20·1 cm3. The maximum dose tolerance to 1 cc of all the plans was within 140% (84 Gy) of the prescribed dose, and 95% of the PTV of all the plans received 100% of the prescribed dose (60 Gy). In all the plans, 99% of the PTV received a dose >90% of the prescribed dose, and the mean dose in all the plans ranged from 67 to 72 Gy. The planning target dose conformity for the SBRT and the VMAT (0°, 15° collimator single arc plans and dual arc) plans showed the tightness of the prescription isodose conformity to the target.

SBRT and VMAT are radiotherapy approaches that increase doses to small tumour targets without increasing doses to the organs at risk. Although VMAT offers an alternative to SBRT for NSCLC and the potential advantage of VMAT is the reduced treatment times over SBRT, the statistical results show that there was no significant difference between the SBRT and VMAT optimised plans in terms of dose conformity and organ-at-risk sparing.

Superficial X-ray therapy units are used for the treatment of certain types of skin cancer and some severe dermatological conditions. The performance assessment and beam characteristics of the superficial unit are very important to ensure accurate dose delivery during patient treatment. Both experimental measurements and Monte Carlo calculations can be used for this purpose.

This study aims to investigate whether it is possible to reproduce experimentally measured data for the XSTRAHL 150 superficial X-ray unit with simulations using the BEAMnrc Monte Carlo code.

The experimental procedure applied in this study included the following: experimental measurements of different X-ray spectra, half-value layers, percentage depth dose and beam profiles. Monte Carlo modelling of the XSTRAHL 150 unit was performed with the BEAMnrc code. The validity of the model was checked by comparing the theoretical calculations with experimental measurements.

There was good agreement (∼1%) between experimentally measured and simulated X-ray spectra. Results of half-value layers obtained from simulated and measured spectra showed that there was a maximum of 3·6% difference between BEAMnrc and measurements and a minimum of 2·3%. In addition, simulated percentage depth dose and profile curves have been compared against experimental measurements and show good agreement (within 2% for the depth dose curves and 3–5% for beam profile curves, depending on the applicator size).

The results of this study provide information about particles’ interaction in different kilovoltage and filter combinations. This information is useful for X-ray tube design and development of new target/filter combinations to improve beam quality in superficial X-ray radiotherapy. The data presented here may provide a base for comparison and a reference for other or potential new users of the XSTRAHL 150 X-ray unit.

The use of bowel preparation strategies to reduce the degree of rectal distension during prostate radiotherapy is well documented. This retrospective pilot study analysed and compared a probiotic agent against a psyllium-supplemented diet to establish the feasibility of probiotics as a bowel preparation for patients receiving radical radiotherapy for prostate cancer.

A retrospective chart review of five patients taking probiotics and five taking psyllium husk (psyllium) during their course of radiotherapy treatment was conducted. On treatment, cone beam computed tomography (CBCT) scans were compared with planning CTs to quantify inter-fractional variation in rectal volume and distension.

Forty-five CBCT scans were available in both the psyllium and probiotics groups for analysis. Variation in mean difference in rectal volume from planning (ΔRV), mean rectal cross-section area (CSA) and mean relative cross-section area (CSArel) was significantly increased for the probiotics group compared with the psyllium group (p=0·001, 0·008 and 0·007, respectively). No statistically significant differences in mean ΔRV, CSA and CSArel were detected between the two groups.

This retrospective analysis suggests that a probiotics-based bowel preparation that utilises Lactobacillus acidophilus and Bifidobacterium lactis may result in increased rectal volume and CSA variation throughout treatment in comparison with a psyllium-supplemented diet.

Cancer patients spend a lot of time receiving medical care. Our study investigates patients’ preferences regarding reducing the time involved in non-palliative radiotherapy care.

A total of 142 Dutch patients were included in our study. Using a contingent valuation survey, we measured the proportion of patients who preferred to reduce their patients’ time, splitting it into five different categories, and, for those who did, whether and how much they were willing to pay for this to happen.

About 50% of the patients preferred to reduce their time waiting for admission by 1 week and their travel time by half; 20 and 62% wanted to reduce their waiting time by half and their treatment time from 20 to 5 minutes, respectively; 36% preferred to be treated 7 instead of 5 days a week; and 20% of those wishing to reduce their patients’ time were willing to pay, and their mean willingness to pay (WTP) ranged from £0·32 to £18·1 per hour’s reduction of their time.

Half of the patients seem to assess their patients’ time as reasonable. The other half preferred to reduce it, but only about 20% of them were willing to pay for it to happen and their mean WTP was low.

The objective of this work was to investigate the accuracy of AAA dose calculation algorithm for RapidArc volumetric modulated technique (VMAT) in the presence of anatomical heterogeneities in the pelvic region.

An anthropomorphic phantom was used to simulate a prostate case, delineating planning target volumes (PTVs) and organs at risk. VMAT plans were optimised in eclipse (v10·0) treatment planning system (TPS). The dose distributions were calculated by the AAA dose calculation algorithm. A total of 49 thermoluminiscent dosimeters were inserted into the anthropomorphic phantom and dose measurements were compared with the predicted TPS doses.

The average dose variation was −1·5% for planning target volume corresponding to the prostate and −0·3% for planning target volume corresponding to the pelvic nodes, −0·2% for the rectum, +2·4% for the bladder, −2·0% for the femoral heads and +1·0% for the intestinal package.

AAA is a reliable dose calculation for the treatment with VMAT in the anatomy of the pelvis.

Radical hypofractionated thoracic radiotherapy is the most commonly used radiotherapy schedule for inoperable non-small-cell lung cancer (NSCLC) in the United Kingdom, despite a lack of level I evidence to support its use.

To supplement existing published retrospective data with a mature data series and provide further evidence to support the use of this schedule in routine clinical practice.

Retrospective analysis of all inoperable NSCLC cases treated with radical hypofractionated radiotherapy with or without induction chemotherapy in the North Wales Cancer Treatment Centre between 2001 and 2011.

Of the 222 patients, 209 (94%) received 55 Gy in 20 fractions (#) and 13 (6%) received 52·5 Gy in 20#. Induction chemotherapy was administered in 121 (55%) cases. The median survival of 28·6 months (95% confidence interval 24·2–32·5) is comparable with previously published survival outcomes for this patient group.

The growing body of evidence for this schedule, confirming survival outcomes comparable with internationally accepted results, is sufficient to support its future use in inoperable NSCLC.

To determine and summarise the literature on prostatic seed stability by investigating seed marker migration and loss in prostate cancer patients. In addition, documenting the implications of significant seed migration and loss in clinical practise.

PubMed and Sciencedirect databases were used to locate papers on the stability of gold seed markers in prostate patients treated with external beam radiation therapy. The search found 3,238 articles and ten articles were selected and reviewed based on inclusion and exclusion criteria for the scope of this literature review.

Minimal migration and loss of seeds was observed in the literature reviewed, with the majority of authors reporting <2·0 mm migration within the prostate; however, there were individual cases reported outside of the 2·0 mm threshold. It was also found that significant migration had an impact on image matching, as well as, planning treatment volume margins.

Seed stability within the prostate has been proven, with most authors reporting minimal migration within a 2·0 mm threshold and minimal loss of seeds. Although individual cases can have significant migration and loss, if marker migration exceeds the 2·0 mm threshold, a protocol is required to deal with both non-significant and significant migration.

To observe the impact of internal mammary node irradiation (IMNI) on disease-free survival (DFS) and overall survival (OS) in postmastectomy women with breast cancer.

Between 1978 and 1996, 153 women with stage II–III breast cancer were treated with postmastectomy radiation therapy (RT) with IMNI. Their clinical, pathological and treatment characteristics were matched with 166 patients without IMNI. The RT dose was 35 Gy to the chest wall and 40 Gy to the supraclavicular fossa and IMN in 15 fractions over 3 weeks with photons. All patients were planned with two-dimensional technique. Adjuvant chemotherapy was administered to 41% and endocrine therapy to 52% of the patients. Symptomatic patients were further assessed for late pulmonary and late cardiac effects.

The median follow-up period was 203 months (range, 182–224), and the median age was 44 years (range 20–73 years). The IMNI group had significantly more right-sided and inner/central quadrant tumours. Other characteristics were comparable between both the groups. DFS at 15 years with and without IMNI was 64 and 49%, respectively (p=0·0001). On multivariate analysis, IMNI was an independent, positive predictor of DFS [hazard ratio (HR), 2·89; p=0·0001]. Benefit of IMNI on DFS was more apparent in inner/central tumours [HR, 1·48; 95% confidence interval (CI), 1·02–2·88], N2–N3 patients (HR, 1·44; 95% CI, 1·09–2·10) and in those who received chemotherapy (HR, 1·70; 95% CI, 1·07–2·71). OS at 15 years with and without IMNI was 68 and 54%, respectively (p=0·0001). Late pulmonary toxicity was 1·5 versus 1% with and without IMNI, respectively. Late cardiac toxicity was 2·6 versus 1·8% with and without IMNI, respectively.

IMNI significantly improved DFS and OS in postmastectomy breast cancer patients. Benefit of IMNI was seen in patients with central/inner tumours and N2–N3 disease. Late cardiopulmonary toxicities were comparable between the two groups.

The combination of radiation therapy and chemotherapy is rooted in its ability to help achieve locoregional and systemic control, therefore increasing the overall disease-free survival of patients. Understanding the mechanistic actions of cytotoxic agents and their targets on the cell cycle, as well as the governing pharmacokinetic principles can improve treatment delivery. The adjuvant treatment setting can overcome barriers such as hypoxia and genetically driven treatment resistance.

The purpose of this review is to present theoretical frameworks behind the chemoradiation paradigm and to describe current chemoradiation practices in radiation oncology.

A review was conducted using the US National Library of Medicine, National Institutes of Health database (PubMed) using the following search keywords: chemoradiation, spatial cooperation, chemotherapeutic agents, pharmacokinetics, anti-vascular agents, tumour vasculature and tumour hypoxia.

Current research has reported several rationales for the beneficial combination of radiation and chemotherapy to eradicate oncological diseases. Mechanisms of action and biological approaches are showing that concurrent treatments, as well as novel agents such as anti-vascular and anti-angiogenic agents may benefit improved treatment outcomes by reducing micro hypoxic environments in tumours. In addition, chemotherapy administered in tandem with radiation enhances cell-killing effects by targeting the cell cycle.

This study compared the acute toxicities reported during radiotherapy treatment using either intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) to deliver a moderate hypo-fractionated treatment for early-stage prostate cancer.

Acute toxicities are routinely reported at the clinical site for all patients using the Common Terminology Criteria for Adverse Events. Toxicity assessment is performed on day 1 of treatment, then once weekly thereafter. The recorded toxicities of 40 cases treated with five-field IMRT, and 32 cases treated using VMAT were retrospectively compared. All cases were prescribed 73·68 Gy in 28 fractions. Eight symptoms were assessed; diarrhoea, proctitis, fatigue, pain, dermatitis, urinary frequency, urinary retention and urinary tract pain.

In terms of the overall toxicity recorded, VMAT was shown to reduce the toxicities of dermatitis, fatigue, pain and urinary frequency (p<0·05). Using IMRT, grade 2 toxicities were reported for proctitis, pain, urinary frequency, urinary retention and urinary tract pain. Using VMAT, grade 2 toxicities were reported for urinary frequency and urinary retention.

The research reported here is one of the first publications to demonstrate that VMAT is associated with decreased toxicities compared with IMRT for the treatment of early-stage prostate cancer.

This study aimed to determine the potential role and guidelines for implementation of skill-based peer mentoring for radiotherapy planning education.

After four weekly mentoring sessions, both Year 3 mentors (n=9) and Year 2 mentees (n=9) were invited to complete a short online questionnaire relating to the impact of the initiative. The tool contained a mixture of Likert-style questions concerning student enjoyment and perceived usefulness of the initiative as well as more qualitative open questions that gathered perceptions of the peer mentoring process, implementation methods and potential future scope.

Several key discussion themes related to benefits to each stakeholder group, challenges arising, improvements and potential future directions. There were high levels of enjoyment and perceived value of the mentoring from both sides with 100% of the 18 respondents enjoying the experience. The informal format encouraged further learning, while mentors reported acquisition of valuable skills and gains in knowledge.

Peer mentoring has a valuable and enjoyable role to play in radiotherapy planning training and helps consolidate theoretical understanding for experienced students. An informal approach allows for students to adopt the most appropriate mentoring model for their needs while providing them with a free space to engender additional discussion.

Combined modality treatment regimens have provided modest gains in locoregional control rates of cancers of the head and neck (HNC), and intensity-modulated radiation therapy (IMRT) has gained widespread use. The methodology for determining contours of the gross tumour volume (GTV) in the radiation treatment plan is often based on combined anatomic and metabolic data from positron emission tomography–computed tomography (PET-CT). This study aimed to retrospectively evaluate the overall survival and disease-free survival outcomes of patients with HNC who received definitive IMRT with or without chemotherapy, planned with PET-CT.

A total of 1,200 patients underwent treatment for HNC during the study period, from 1 January 2002 to 31 December 2010. Of those, 261 cases had evaluable data that met the inclusion criteria for the study. The incidence and timing of locoregional recurrence, distant metastatic disease, new primary malignancies and death were evaluated retrospectively. Overall and disease-free survival (survival to time of first recurrence) were determined by the life table method. Incidence of distance metastatic disease and additional cancers were also studied.

Median follow-up from treatment initiation was 26·4 months (range 1·2–84·7 months). Overall survival and disease-free survival rates were 0·883 and 0·791, respectively, at 1 year; 0·793 and 0·688, respectively, at 2 years; and 0·732 and 0·619, respectively, at 3 years. The cumulative risk of recurrence was 22·6% at 3 years following definitive IMRT and the median time to recurrence was 345 days. There was an overall low incidence of distant metastatic disease (3·07%) and additional cancers (8·05%).

Overall and disease-free survival outcomes of a large cohort of HNC patients treated with definitive IMRT radiotherapy following treatment planning with PET-CT shows a similar high level of disease control and mortality rate as previously published outcome studies of shorter terms and/or smaller numbers of patients.

This single-case feasibility study presents an undergraduate radiotherapy student’s experiences of remote access to University treatment planning software in place of on-site practical learning. With clinical sites increasingly utilising telemedicine there is interest in educational applications of this technology.

This was an unplanned study with the student initiating remote access; additional tutor support was provided as requested. Subsequent discussion between the tutor and student formed the basis for the presented findings.

A second-year student planned five assessment cases from home, supported by regular on-campus tutorials. The student saved a 2-hour journey per practical and gained additional planning practice time. Unit performance was 10% less than a previous Unit, but student satisfaction with the format was high.

Educational remote access to treatment planning software is logistically feasible, although strict guidelines and formal tutor support is vital. Remote access can alleviate pressure on facilities and improve student time efficiency. Controlled and supported provision of remote access to planning software could enhance on-site practical teaching sessions for more mature independent learners. Further cohort-wide studies could clarify advantages, disadvantages and possible role of remote access for radiotherapy planning education.

To establish whether the use of a passive or active technique of planning target volume (PTV) definition and treatment methods for non-small cell lung cancer (NSCLC) deliver the most effective results. This literature review assesses the advantages and disadvantages in recent studies of each, while assessing the validity of the two approaches for planning and treatment.

A systematic review of literature focusing on the planning and treatment of radiation therapy to NSCLC tumours. Different approaches which have been published in recent articles are subjected to critical appraisal in order to determine their relative efficacy.

Free-breathing (FB) is the optimal method to perform planning scans for patients and departments, as it involves no significant increase in cost, workload or education. Maximum intensity projection (MIP) is the fastest form of delineation, however it is noted to be less accurate than the ten-phase overlap approach for computed tomography (CT). Although gating has proven to reduce margins and facilitate sparing of organs at risk, treatment times can be longer and planning time can be as much as 15 times higher for intensity modulated radiation therapy (IMRT). This raises issues with patient comfort and stabilisation, impacting on the chance of geometric miss. Stereotactic treatments can take up to 3 hours to treat, along with increases in planning and treatment, as well as the additional hardware, software and training required.

Four-dimensional computed tomography (4DCT) is superior to 3DCT, with the passive FB approach for PTV delineation and treatment optimal. Departments should use a combination of MIP with visual confirmation ensuring coverage for stage 1 disease. Stages 2–3 should be delineated using ten-phases overlaid. Stereotactic and gated treatments for early stage disease should be used accordingly; FB-IMRT is optimal for latter stage disease.